It’s fairly well-established that poverty is not only a social and economic issue, but a huge public health concern as well — particularly when it comes to children. According to the American Academy of Pediatrics (AAP), 22 percent of children in the U.S. live under the federal poverty level. That’s a huge chunk of the population that has a higher risk of chronic health conditions and mental health problems than children in wealthier households.

A new study out of AAP now finds that the percentage of kids with chronic health conditions is growing, and it’s even more widespread among children living in poverty. The study found that asthma and attention-deficit hyperactivity disorder (ADHD), in particular, had especially high rates among children in poverty. And kids with asthma and/or ADHD were about twice as likely to have another chronic condition, like developmental delays, autism, depression, behavioral issues, or even epilepsy.

The researchers used income reporting on parent-completed surveys to examine chronic conditions among kids. They adjusted for gender, race/ethnicity, and age, and took income and insurance type into account as well. To define what constituted “poverty,” the researchers turned to the distribution of total population by the federal poverty level: 0-99 percent and 100-199 percent.

“[W]e need to be aware that poor children already are at greater risk of common childhood illnesses such as asthma, ADHD and autism often face even more medical conditions on top of these,” said Dr. Christian Pulcini, lead author of the study, in a statement.

Health isn’t only determined by genetic or environmental factors, but also by social and economic factors. Poverty's detrimental effect on health stems from the resulting social exclusion, lack of education, unemployment, or lack of access to medical care, among others; each factor impacts mental and physical health. It can heighten a child’s risk for the development of neurological disorders, flu-related hospitalizations, impaired cognitive function and resulting low test scores, as well as chronic stress.

People living in poverty experience “a greater concentration of risks,” Pulcini told Medical Daily, “such as environmental factors (including environmental toxins), poor nutrition due to food insecurity, lack of education on chronic medical conditions, toxic stress,” as well as reduced access to quality health care by way of insurance and transportation.

As a result, Pulcini notes that poverty is so broad and multi-faceted that it will take more than the medical community to combat it.

“What our concerted efforts would hopefully lead to is significant policy bolster education, public health efforts, and mitigate environmental exposures in poverty-stricken communities,” he said.

Source: Pulcini C, Zima B, Kelleher K, Houtrow A, et al. American Academy of Pediatrics, 2016.